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The period survival guide

Dr Venita Patel photo

Created: 28 February, 2018

Updated: 16 July, 2018

Periods are a natural part of most women’s lives, from puberty to menopause. For some Aunt Flo arrives and passes with little disruption, but for others it brings misery and pain.

Even if your monthly visitor fills you with dread, for most women, it means that everything is working as it should be. Luckily, besides curling up in a ball with a hot water bottle and watching Netflix, there are a few things you can do to make your periods a whole lot less miserable.

First up, here’s Dr Faiza Khalid to explain how your GP can help you manage your symptoms.

Keep track


There’s nothing worse than being caught off guard. Tracking your menstrual cycle will give you a heads-up when your period is due, and give you an idea about when you are at your most fertile if you are sexually active.

Most menstrual cycles are between 21 and 35 days long. A period will normally last anywhere between two and seven days. The heaviest bleeding tends to be in the first two days.

There are plenty of apps to help you keep track, or you can of course resort to the good old fashioned method of marking your cycle on your calendar.

What to watch out for


Some women barely get any symptoms of an impending period, but most do notice some around a week or two before, usually in the form of bloating, headaches, acne and irritability.

When these symptoms are unpleasant enough to interfere with day-to-day life, and persist month after month, it’s considered premenstrual syndrome (PMS). This affects 5-10% of menstruating women.

Below are some common symptoms of PMS:

  • Mood swings, feeling depressed or easily irritable
  • Feeling upset, anxious or emotional
  • Headaches
  • Food cravings or change in appetite
  • Feeling clumsy or accident prone
  • Increasing tiredness or trouble sleeping
  • Painful, swollen or tender breasts
  • Fluid retention and bloating
  • Change in bowel habit

However, up to 100 different symptoms have been identified.

Managing symptoms


Addressing lifestyle factors alone may help to alleviate most mild to moderate PMS symptoms. Try to:

  • Get regular exercise. Try to aim for 150 minutes of moderate intensity aerobic activity every week. For example walking, swimming and cycling. Exercise is hugely beneficial; it will improve your overall health and alleviate low mood and fatigue.
  • Combat stress levels by doing more stretching and breathing exercises, such as yoga and pilates, which are known to also help improve sleep.
  • Make sleep a priority and get at least 7-8 hours each night. Lack of sleep is linked to depression and anxiety and can make PMS symptoms such as mood swings worse.
  • Stop smoking and curb your alcohol intake. This will help, as you’ll restrict the amount of salt and caffeine in your diet.
  • Try to stick to whole foods and focus on eating a diet full of different coloured vegetables.
  • Include plenty of leafy greens, which are rich in phytonutrients, vitamins and minerals.
  • Brown rice, pasta and sweet potatoes are a good option if you crave carbohydrates.
  • Opting for at least 70% dark chocolate, berries or some almond nut butter helps to provide magnesium, antioxidants and calcium respectively; nutrients your body yearns for during this time.
  • Remember to keep up with your intake of oily fish twice a week, which contain natural anti-inflammatory omega-3 fatty acids.
  • Keep well hydrated. Dehydration can aggravate period cramps and make bloating worse.

Medical treatments


There are many medical treatments available, and it may be that you have to try several before you find one that suits.

The treatment will be unique to the types of symptoms that affect you and their severity, whilst balancing the risk of side effects of the medication. You might be given:

  • Painkillers such as paracetamol, or non-steroidal anti-inflammatories such as ibuprofen or mefenamic acid for headaches or breast tenderness.
  • Combined oral contraceptive pills, which can improve PMS by preventing ovulation.
  • Selective serotonin reuptake inhibitors (SSRIs). These are usually prescribed in severe cases of PMS and are an off-label use.
  • Gonadotropin-releasing hormone (GnRH) analogues will often be prescribed by specialists. They are used in severe cases of PMS and are a synthetic hormone injected to cause a temporary menopause, stopping your periods by blocking the production of oestrogen and progesterone.

Your GP may refer you for cognitive behavioural therapy (CBT). This technique provides you with new ways of managing some of the psychological symptoms to help reduce their impact on your daily life.

Complementary therapies


There is evidence to suggest that supplementation with vitamin D, calcium, vitamin B6, magnesium or Agnus castus (a herb known as chasteberry) may be helpful in dealing with PMS.

Evening primrose oil may help to reduce breast tenderness. Before you take any vitamin, herb, or mineral supplement, speak with your doctor or pharmacist to ensure it is safe for you to use.

If you are getting symptoms on a monthly basis and find that these are interfering with your personal, social or professional life then you should speak to a GP, period!

Using nutrition to support healthy menstruation

To help ensure a healthy menstrual cycle, Dr Venita Patel advises that it is useful to pay attention to your energy levels, appetite and cravings through the phases of the cycle.

You can then adjust your exercise and eating patterns accordingly. Try to have regular meals, with protein at each meal, to help keep blood sugar levels stable.

Certain micronutrients are also beneficial for female hormone production and balance, including B-vitamins (particularly B6), magnesium, and omega-3 fats.

Adequate fibre intake and fluids are also important for healthy elimination of oestrogen breakdown products.

Early Follicular Phase (Days 1-4)


During your period, your energy may be at its lowest levels, so you may prefer light exercises like yoga, walking, or stretching.

Your appetite may also reduce, so try to adjust your eating habits to match your energy needs, perhaps with with smaller meal portions and fewer snacks.

Iron-rich foods (dark green vegetables, beetroot, dried fruit and red meat) are useful to replenish your supplies for blood cell production. Magnesium-rich foods (dark green leafy vegetables, nuts, seeds, whole grains) are helpful for muscle relaxation. Remember to keep well hydrated too.

Recipe idea: Roast beetroot with feta, walnuts and seeds on a bed of garlicky wilted spinach.

Late Follicular Phase (Days 5-15)


Your energy should be increasing, so you can increase exercise intensity. You may become hungry, so try adding extra healthy fats (avocado, olive oil, nuts) and protein to your meals for improved satiety and blood sugar balance.

You will also benefit from choosing complex carbohydrates (such as oats, beans, brown rice, quinoa and starchy vegetables) over refined ones.

Recipe idea: Mexican bean chilli with brown rice and guacamole.

Luteal Phase (Days 16-28)


You tend to have most energy at this stage, can sustain longer workouts, and also crave more energy-dense foods at this time.

Have a balance of healthy fats and protein, plus complex carbohydrates and snacks as needed. During the last four days of your cycle (pre-menstrual), eating some dark chocolate or cacao and extra nuts or nut butter can help satisfy your cravings, and provides extra magnesium before your period.

Recipe idea: Chia and oat porridge with nut butter, banana, cinnamon and cacao.

More health advice

Topics: Expert health advice, Women's health